High frequencies of response after limited primary therapy for multiple myeloma

Background: Recent bortezomib combinations have induced remission in approximately 90% of patients newly diagnosed, with moderate frequency of adverse effects. Patients: In an attempt to reduce adverse effects, and to prepare qualified patients for early intensification, we assessed the antimyeloma effect and toxicity of 3 different bortezomib combinations in small numbers of patients. Methods: With reduced doses and short durations of exposure, we combined bortezomib with (a) cyclophosphamide/dexamethasone, (b) lenalidomide/dexamethasone/liposomal doxorubicin, and (c) cyclophosphamide/ dexamethasone/lenalidomide. Results: Response rates were high, with rare episodes of severe drug-related toxicity. Conclusions: Further study of similar combinations of effective drugs given in limited doses and for short durations would be useful.